Transhepatic Balloon Dilation of Biliary Strictures in Liver Transplant Patients: A 10-year Experience

Zajko, Albert B.; Sheng, Rubin; Zetti, Giorgio; Madariaga, Juan; Bron, Klaus M.

doi:10.1016/s1051-0443(95)71063-6

Cited by 105 publications

(69 citation statements)

References 15 publications

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“…Previously, others have described successful treatment of NAS with a number of modalities. 3,[14][15][16][17] We did not study the success of treatment in these patients because the group of patients treated with therapeutic ERCP, PTCD, or surgery was too small (28 cases), the group was heterogeneous concerning location and severity of abnormalities, and several types of treatment modalities were used. However, in most patients, an improvement in liver test results was seen, although this is not synonymous with uneventful longterm outcome.…”

Section: Discussionmentioning

confidence: 99%

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Nonanastomotic biliary strictures after liver transplantation, part 2: Management, outcome, and risk factors for disease progression

et al. 2007

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Nonanastomotic biliary strictures (NAS) after orthotopic liver transplantation (OLT) are associated with high retransplant rates. The aim of the present study was to describe the treatment of and identify risk factors for radiological progression of bile duct abnormalities, recurrent cholangitis, biliary cirrhosis, and retransplantation in patients with NAS. We retrospectively studied 81 cases of NAS. Strictures were classified according to severity and location. Management of strictures was recorded. Possible prognostic factors for bacterial cholangitis, radiological progression of strictures, development of severe fibrosis/cirrhosis, graft survival, and patient survival were evaluated. Median follow-up after OLT was 7.9 years. NAS were most prevalent in the extrahepatic bile duct. Twenty-eight patients (35%) underwent some kind of interventional treatment, leading to a marked improvement in biochemistry. Progression of disease was noted in 68% of cases with radiological follow-up. Radiological progression was more prevalent in patients with early NAS and one or more episodes of bacterial cholangitis. Recurrent bacterial cholangitis (Ͼ3 episodes) was more prevalent in patients with a hepaticojejunostomy. Severe fibrosis or cirrhosis developed in 23 cases, especially in cases with biliary abnormalities in the periphery of the liver. Graft survival, but not patient survival, was influenced by the presence of NAS. Thirteen patients (16%) were retransplanted for NAS. In conclusion, especially patients with a hepaticojejunostomy, those with an early diagnosis of NAS, and those with NAS presenting at the level of the peripheral branches of the biliary tree, are at risk for progressive disease with severe outcome. Liver Transpl 13: [725][726][727][728][729][730][731][732] 2007. © 2007 AASLD.Received September 19, 2006; accepted February 15, 2007. Biliary complications are common after orthotopic liver transplantation (OLT). Biliary strictures and leakage of bile are most frequently encountered. Strictures are often referred to as anastomotic or nonanastomotic. Nonanastomotic biliary strictures (NAS) are generally considered to be the most troublesome type of biliary complications after liver transplantation, with a graft loss rate of up to 46% after 2 years. 1In a separate study, we have analyzed the radiological characteristics of NAS at the time of diagnosis and risk factors for the development of NAS.2 In this study, we were able to identify statistically significant differences in risk factors for the development of NAS depending on the time of initial presentation. In addition, large variations in anatomical localization and severity of NAS at the time of presentation were found, indicating that NAS is not a single disease but rather a group of biliary abnormalities with different pathogenesis. It is unAbbreviations: NAS, nonanastomotic biliary strictures; OLT, orthotopic liver transplantation; PTCD, percutaneous transhepatic cholangiodrainage; ERCP, endoscopic retrograde cholangiopancreaticography; RR, relati...

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Section: Discussionmentioning

confidence: 99%

“…Nineteen had to be admitted repeatedly for recurrent bacterial cholangitis (defined as 3 or more episodes). The median number of cholangitis episodes in these 19 was 5 (range [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Thirty patients were placed on maintenance antibiotic therapy, mostly ciprofloxacin, for some time.…”

Section: Cholangitis Episodesmentioning

confidence: 99%

Nonanastomotic biliary strictures after liver transplantation, part 2: Management, outcome, and risk factors for disease progression

et al. 2007

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“…These results are better than those of previous studies, 23,24 except for those of Zajko et al, who reported a success rate of 80% at 6 months and 70% at 5 years in a series of 72 patients with both anastomotic and nonanastomotic BS. 21 Early BSs (Ͻ 3 months) are considered to have a good response after balloon dilatation. 23 We found early narrowing of the anastomosis in 6 patients, which was managed successfully with prolonged drainage through the bile tube, avoiding PTM.…”

Section: Choice In Treatment Of Bsmentioning

confidence: 99%

Long-term results of percutaneous management for anastomotic biliary stricture after orthotopic liver transplantation

Roumilhac

Poyet

Sergent

et al. 2003

Liver Transplantation

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The purpose of this study was to evaluate the results of percutaneous transhepatic management (PTM) of anastomotic biliary strictures (BS). Among 168 liver transplant adult recipients, BS was identified in 30 patients. In 6 patients, narrowing of the anastomosis was found early, and in all cases disappeared spontaneously with prolonged draining of the bile tube. Within a mean time of 14 months after transplantation, 24 patients had symptomatic BSs, revealed by cholestasis (n ‫؍‬ 17) or cholangitis (n ‫؍‬ 7). Twenty-two patients underwent PTM as first treatment of BS (balloon dilatation or stent placement). We evaluated the primary and secondary patency rate of PTM. In 1 patient, PTM failed because the stricture could not be passed with the guide wire, necessitating conversion to a Roux-en-Y choledochojejunostomy (CDJ). Fourteen patients were treated by percutaneous balloon dilatation from which 8 patients (57.2%) were recurrence-free with a mean follow-up of 61 months. One patient with a patent biliary anastomosis underwent retransplantation for acute rejection. Twelve patients received metallic expandable stent placement as their primary treatment (n ‫؍‬ 7) or after failure of balloon dilatation (n ‫؍‬ 5). Recurrent stricture was found in 7 cases (58%) and was treated by PTM (n ‫؍‬ 6) or surgery (n ‫؍‬ 1). The primary patency rate for PTM was 58.8% at 12 months and the secondary patency rate 88.4%, with a mean follow-up of 47 months (median: 44 months). The mortality rate was 3.5% (one death). PTM with balloon dilatation, stent placement, or both, represent a safe method to treat anastomotic BSs after orthotopic liver transplantation (OLT) resulting in a secondary patency rate of 88% at 5 years. (Liver Transpl 2003;9:394-400.) P reviously biliary complications after orthotopic liver transplantation (OLT) have been reported as a perioperative and a middle long-term event in 10% to 40% of patients 1-3 and even nowadays remain an important cause of morbidity after the surgical procedure. 4 Biliary strictures (BS) are reported to occur in 9% to 15% of adult OLT recipients with choledochojejunostomy (CDJ) or choledochocholedochostomy (CDC) and are frequently localized at the anastomosis. 2,5-7 BSs appear also to be a problem in living related liver transplantation. [8][9][10] However, the management of these BSs remains controversial. In a recent survey, 22% of transplant centers in United States reported the use of percutaneous transhepatic management (PTM), whereas 29% chose reoperation and 45% used endoscopic retrograde cholangiography (ERCP). 11 Considering the potential risks of surgical reintervention, we decided in 1990 to treat BSs with PTM as a first approach. The objectives of this retrospective study were to evaluate the longterm outcome and results of systematic PTM for anastomotic BS after OLT. Patients and MethodsBetween July, 1987 and December, 2000, 216 consecutive OLT were performed in our center. To evaluate the middleand long-term outcome of BS, 168 adult patients (85 male and 83 female, age 15 t...

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“…Some studies have suggested that biliary stricture occurs more frequently in post-LDLT patients than in deceased liver transplantation because of the small diameter of the anastomotic portion of the bile duct, anatomical diversity of the bile ducts, or the complicated nature of the surgical procedure [9,10,18] . There are two strategies for treating anastomotic strictures: via the endoscopic retrograde approach [19] or the percutaneous transhepatic approach [20] . The endoscopic retrograde approach is feasible for posttransplant patients with a duct-to-duct anastomosis, and endoscopic stent placement has been reported to be effective for biliary strictures in post-transplant patients [21] .…”

Section: Ir For Anastomotic Biliary Stenosismentioning

confidence: 99%

Interventional radiology for post-transplant anastomotic complications

Shibata¹

2017

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How to cite this article: Shibata T. Interventional radiology for post-transplant anastomotic complications. Hepatoma Res 2017;3:221-7.The effectiveness of percutaneous interventional radiology for anastomotic stricture in hepatic vein, portal vein, and biliary tract after living donor liver transplantation (LDLT) is described. As a number of patients with LDLT are infants < 10-year-old in the study, the first treatment option was balloon dilatation, not primary stenting. However, stent placement was performed in patients with recurrent, repeated stenosis. Key words:Interventional radiology, living donor liver transplantation, balloon dilatation, stent placement ABSTRACTArticle history:

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Transhepatic Balloon Dilation of Biliary Strictures in Liver Transplant Patients: A 10-year Experience

Cited by 105 publications

References 15 publications

Nonanastomotic biliary strictures after liver transplantation, part 2: Management, outcome, and risk factors for disease progression

Nonanastomotic biliary strictures after liver transplantation, part 2: Management, outcome, and risk factors for disease progression

Long-term results of percutaneous management for anastomotic biliary stricture after orthotopic liver transplantation

Interventional radiology for post-transplant anastomotic complications

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